Provider Demographics
NPI:1063386662
Name:REBECCA TRAUGOTT RN IBCLC
Entity type:Organization
Organization Name:REBECCA TRAUGOTT RN IBCLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:TRAUGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN IBCLC
Authorized Official - Phone:870-370-0838
Mailing Address - Street 1:510 E BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-5310
Mailing Address - Country:US
Mailing Address - Phone:870-370-0838
Mailing Address - Fax:
Practice Address - Street 1:510 E BRADLEY ST
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-5310
Practice Address - Country:US
Practice Address - Phone:870-370-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty